Provider Demographics
NPI:1295853844
Name:CENTURY FORT STOCKTON GEAC LLC
Entity Type:Organization
Organization Name:CENTURY FORT STOCKTON GEAC LLC
Other - Org Name:FORT STOCKTON NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-464-7018
Mailing Address - Street 1:501 N SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-4602
Mailing Address - Country:US
Mailing Address - Phone:432-336-7631
Mailing Address - Fax:432-336-8870
Practice Address - Street 1:501 N SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-4602
Practice Address - Country:US
Practice Address - Phone:432-336-7631
Practice Address - Fax:432-336-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112531314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005310Medicaid
TX675722Medicare ID - Type Unspecified